J Clin Neurol.  2005 Oct;1(2):177-179. 10.3988/jcn.2005.1.2.177.

Primary Medullary Hemorrhage Associated with Hypertension

• Kwon HM
• Park JM
• Lee JY
• Yoon BW

• KMID: 1808489
• DOI: http://doi.org/10.3988/jcn.2005.1.2.177

Abstract

Spontaneous primary medullary hemorrhage is a rare event. A 64-year-old man was admitted for sudden-onset vertigo and vomiting. His clinical features were similar to those of lateral medullary syndrome. The patient had no anticoagulant therapy, vascular malformation, or a caudal extension of a pontine hemorrhage. The patient had multiple hypertensive changes, including retinopathy, left ventricular hypertrophy on electrocardiography, multiple cerebral microbleeds, and small-vessel changes on MRI. T2*-weighted gradient echo MRI performed 3 months prior to admission and contrast-enhanced MRI showed no evidence of vascular malformation. We concluded that the patient had uncontrolled hypertension that may have lead to primary medullary hemorrhage.

Keyword

Hemorrhage; Medulla; Hypertension; MRI

MeSH Terms

Electrocardiography
Hemorrhage*
Humans
Hypertension*
Hypertrophy, Left Ventricular
Lateral Medullary Syndrome
Magnetic Resonance Imaging
Middle Aged
Vascular Malformations
Vertigo
Vomiting

Figure

• 

  Figure 1 Brain images of the patient before admission. Three months prior to admission, T2*-weighted GRE MRI showed multiple cerebral microbleeds in the thalamus (A) with no abnormal vasculature in the medulla (B). The fluid-attenuated inversion recovery image showed diffuse periventricular white-matter changes (C).

• 

  Figure 2 Brain images of the patient at admission. Brain CT (A, B) and T2*-weighted GRE MRI (C, D) showed hemorrhage in the left dorsal medulla, which ruptured the dorsal medulla and extended into the fourth ventricle (arrow). The layered blood-CSF pattern of the intraventricular hemorrhage was due to backward flow of blood into the occipital horn of the left lateral ventricle (D) (arrowhead).

Reference

1. Mastaglia FL, Edis B, Kakulas BA. Medullary hemorrhage: a report of two cases. J Neurol Neurosurg Psychiatry. 1969. 32:221–225.

2. Kempe LG. Surgical removal of an intramedullary haematoma simulating Wallenberg\'s syndrome. J Neurol Neurosurg Psychiatry. 1964. 27:78–80.

3. Cohen HC, Tucker WS, Humphreys RP, Perrin RJ. Angiographically cryptic histologically verified cerebrovascular malformations. Neurosurgery. 1982. 10:704–714.

4. Morel-Maroger A, Metzger J, Bories J, Gardeur D, Verger JB, Noel MC. Non-lethal brain stem hematomas in hypertensive patients. Rev Neurol (Paris). 1982. 138:437–445.

5. Biller J, Gentry LR, Adams HP Jr, Morris DC. Spontaneous hemorrhage in the medulla oblongata: clinical MR correlations. J Comput Assist Tomogr. 1986. 10:303–306.

6. Barinagarrementeria F, Cantu C. Primary medullary hemorrhage. Report of four cases and review of the literature. Stroke. 1994. 25:1684–1687.

7. Neumann PE, Mehler MF, Horoupian DS. Primary medullary hypertensive hemorrhage. Neurology. 1985. 35:925–928.